Pediatric cataracts are more common and problematic than previously thought

Three days after the birth of Canyon Brown, the pediatrician discovered a problem.

During a standard red reflex test, in which a red dot of light is illuminated by an ophthalmoscope in the pupil, the boy’s right eye, unlike his left, does not reflect light back.

The cataract present in Canyon Brown’s right eye at birth was removed at 6 weeks of age.

People can be born with cataracts. They can form them at any time in life. Lens opacity is not just an artifact of old age. According to the American Academy of Ophthalmology, the incidence of infantile cataracts is 3 to 4 per 10,000 live births per year. They account for 5 to 20 percent of child blindness worldwide.

An even lesser known fact is that cataracts are much more serious in infants than in adults.

People always think, “Oh, my grandfather had his cataract removed and the operation was released in 20 minutes and he never saw a surgeon again, no big deal,” but the opposite is true with children.

Jolin Rudel, PhD, PhD, Pediatric Ophthalmologist, Shiley Eye Institute, UC San Diego Health

Rudel removed Canyon’s cloudy lens at 6 weeks of age. This is considered an emergency operation for several reasons, each of which distinguishes pediatric cataract from the type of adult.

“One of the things we always worry about is cancer,” Rudel said, explaining that retinoblastoma can sometimes look like congenital cataracts, but if detected can require “radiation, chemotherapy and possibly even eye removal.” treatment.

“It was horrible for us,” said Rochelle Godet, Canyon’s mother. “We have a newborn who could probably have this life-threatening disease?”

In the case of Canyon, no tumor was found. His cataract is due to an unexplained underdevelopment of the eye in the womb. (If Canyon has developed cataracts in both eyes that may have been a sign of a more serious problem, such as an infection or a genetic syndrome that could affect a child’s development and health.)

Whatever the cause, cataract treatment is also much more urgent for infants than for adults, as the brain begins to exclude the sight of the evil eye immediately after birth. Therefore, like most people who develop cataracts in early childhood, Canyon also has amblyopia (more commonly called lazy eye).

“There is a very short period of time during which we can operate, which is four to six weeks, to have a chance to save all vision in the eye,” said Rudel, who regularly performs these operations, “because from day one, the brain favors the eye without cataracts. “

Finally, the treatment of cataracts is much more complicated in infants, as blurred lenses cannot be immediately replaced with artificial ones. The eyes continue to grow and change shape, according to Rudel. So Canyon has to wear contact lenses or very thick glasses to have some focusing power in his problem eye until he grows up a little, when his parents have the opportunity to do an intraocular transplant or continue with the contact lens indefinitely.

Canyon Brown, shown with his mother at 18 months, should cover his unaffected eye with a patch for 3 to 6 hours a day to strengthen his affected eye.

“When he wakes up, you have to clean the contact lens and then try to open his eyeball and insert it without him pulling your hand away, screaming or convulsing,” Godet said. “And the glasses don’t work because he won’t wear his glasses anymore. He takes them off.”

Due to its amblyopia, Canyon also has to wear a patch on his unaffected eye for three to six hours a day to strengthen his problem eye.

“It really changed the routine of our whole family,” Godet said, “and there are things that come up every step of the way.”

Rudel called correcting cataracts in babies a “lifelong process.”

“At any time after the operation, from days to decades later, there are many potential problems that may arise and possibly additional operations to correct them,” she said. “Even if their surgeries are going perfectly and the right things are being done at the right time, children born with underdeveloped eyes are more at risk for glaucoma and other forms of blindness. Some of them may lose their sight anyway.”

And the cost of this treatment can break the bank of the average family. Canyon’s lancectomy alone cost $ 35,000, as it was charged to his insurance company, which rejected the lawsuit. Fortunately, the cash payment agreement for Godet and her husband cost only $ 8,200, which was fully supported by generous friends and family through the GoFundMe campaign.

Many families end up deciding that it’s not worth all the trouble just to keep sight in one eye, according to Rudel.

“It can be a difficult decision to put a six-week-old child under anesthesia for something that won’t kill him,” Rudel said. “After all, you can still legally drive with one eye only, and Canyon will still be able to do what other children can do.

Jolene Rudell, MD, PhD, is a pediatric ophthalmologist at the Shiley Eye Institute at UC San Diego Health.

The problem, Rudel said, is if something happens to the unaffected eye.

“When a child grows up and develops macular degeneration, which worsens in their good eye, they become essentially blind,” she said. “That’s why we always try to maximize any vision we can when we can.”

Rudel says more research is needed into congenital cataracts.

“We have options for treating patients like Canyon, but we still don’t have great solutions and there are still so many questions about what is the best way to manage congenital cataracts,” she said. “Unfortunately, it has not been well studied. But I hope that more research can only help improve visual performance in children with eye diseases, including cataracts.”

So far, Canyon is healthy and developing normally at 18 months, which is what his parents are focusing on.

“He interacts well with others and his language develops well,” Godet said. “I almost think he can get ahead in some way. She paused, adding, “It’s not like a walk in the park, but just the fact that you can treat it makes us just want to do it and hope for the best.”


Medical School at the University of California, San Diego

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